Provider Demographics
NPI:1780218685
Name:SISU COUNSELING PC
Entity Type:Organization
Organization Name:SISU COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER, CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SKAVDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP, PCMSW
Authorized Official - Phone:308-665-5031
Mailing Address - Street 1:40099 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:NE
Mailing Address - Zip Code:69357-3529
Mailing Address - Country:US
Mailing Address - Phone:308-665-5031
Mailing Address - Fax:
Practice Address - Street 1:40099 4TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:NE
Practice Address - Zip Code:69357-3529
Practice Address - Country:US
Practice Address - Phone:308-665-5031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty